Body armor for EMS: Is it time for every medic to wear a ballistic vest?

From the Editorial Director

Paramedic chiefs and EMS leaders need to answer these questions before purchasing body armor for their medics

EMS agencies across the United States are adding or considering body armor as required personal protective equipment for their EMTs and paramedics. Recent news of ballistic vests, secured through budget allocation, grants or donation, has come from Cleveland, Wisconsin, Pennsylvania, New Jersey, Michigan, Ohio, and Colorado.

The purchasing decisions are driven by a combination of both actual incidents of violence against EMS providers and a perceived increase in the day-to-day threat of violence to medics. The implementation of the rescue task force model, which puts EMS providers into the warm zone of an active shooter incident, is also certainly playing a role. A Pennsylvania EMS agency is purchasing body armor for all of their responders after some personnel began purchasing it on their own.

Paramedic chiefs and EMS leaders, rather than simply following the purchasing decisions of neighboring departments, should understand the functionality of body armor, the potential functional complications for medics wearing vests, and the long-term impact of maintaining and replacing another piece of department-issued PPE. Here are questions your department should ask before purchasing body armor or seeking an EMS grant to purchase body armor.

Is the need for body armor supported by evidence?We regularly report news of violence against EMS providers. These anecdotes though have not been compiled into a database that can report the frequency of shots fired on medics or medics stabbed per 100,000 patient encounters.

Since the scope of the problem is not understood nationally, what is the local data? How often do medics in your service or region come under fire, engage in hand-to-hand combat, or face an attacker with a knife?

What does body armor protect against? Some of the most violent assaults reported on medics are from knives and box cutters, not guns. Body armor that does not provide stab or slash protection leaves medics vulnerable to these close-quarters assault injuries that can happen suddenly.

Two Detroit medics, attacked by a patient's friend, were slashed in the face, neck and hands. Body armor, even if slash resistant, would have done little to prevent those injuries. Two San Diego firefighter/paramedics were stabbed in the back and flank by a bystander. Body armor, generally not designed to stop a penetrating knife, might not have changed the severity of their injuries.

What is the department policy for body armor use?There is wide variability in department policies. Some departments are now requiring medics to wear body armor on every patient encounter. In Cleveland, body armor is required at all times except when inside a station, hospital or training room. Other departments prescribe body armor for certain types of incident responses, such as gunshot victim, stabbing victim, active shooter or assault.

The sometimes usage approach creates a problem of policy enforcement and adds an extra step to the response phase. When responding from a station, the PPE selection and donning, based on the dispatch information, seems sensible. Much like firefighters choose wildland, hazmat or structural turnout gear based on the incident type.

Medics, responding from a posting location, are less likely to be able to easily incorporate the donning of PPE, like a vest, into the response phase. They are almost certainly most likely to don the vest once they arrive at the scene — creating a moment of vulnerability when the scene tension is at its highest and there has been no medic action to stabilize the scene.

Opposite of a department mandate to wear body armor on ever call is a policy which puts the decision to wear a ballistics vest up to the medic. These discretional policies result in a wide variability of usage, the likelihood that some providers are wearing a vest while others, at the same incident, are not.

Are there EMS-functional body armor products? The body mechanics, postures and movements of a paramedic are much different than a patrol officer or SWAT operator. Some medics spend long periods of time sitting in a vehicle and then suddenly need to ascend a set of stairs, crawl into a ditch, or drag a pulseless patient out of a cramped bathroom. Lifting stretchers, carrying a first-in bag and cardiac monitor, and performing two-minutes of chest compressions is a unique task set for medical providers. Pilot test different body armor products of various weights, cuts and thickness on the job. Ask a physically diverse team of providers to score and rank the vests for suitability to EMS work environment. Don't make a purchase of a poorly suited product simply to make a purchase. A poor-fitting vest that compromises a medic's ability to do their job will be quickly discarded and the policy will drift toward user discretion.

Are the vest colors and labels specific to EMS? If the body armor will be worn over a uniform button-down shirt, polo, or T-shirt there needs to be careful consideration to the color and labeling on the vest. Buying a blue or black vest doesn't differentiate medics from cops. In some communities concern over the para-militarization of EMS providers might be further off-putting to the civilians your department is serving.

Red, yellow or green helps the caregivers standout, but does that create an easy to see and identify target? Each department should discuss what's more effective in their community — looking like a cop or standing out from the cops.

A concealable vest, worn under a uniform shirt, is another option to consider. A concealable vest though likely causes a secondary expenditure for the department or personnel to replace uniform shirts with a larger size to accommodate the vest. A Chicago medic was ordered to wear a ballistic vest he purchased under his uniform.

How many vests need to be purchased? Some departments are purchasing vests for each provider. Much like every medic has their own uniform coat. Other departments are purchasing two vests per ambulance, just like each equipping each ambulance with two high-visibility reflective vests for responses on the road or highway. Body armor, not fitted to an individual, needs to fit a range of responders and be easily adjustable. It also becomes part of the shared inventory of the ambulance for which every crew is responsible for checking and maintaining.

How will the department sustain its body armor inventory? A ballistic vest, like any form of reusable PPE, is subject to wear and tear. All the time, on-duty use is going to lead to spills, stains, abrasions, UV degradation and possible contamination by bloodborne pathogens.

During the purchasing process investigate the durability of the body armor, what components are easily repaired and which components require replacement. The condition of body armor, worn as an outer uniform layer, should have the same shine and polish as the department's vehicles and other uniform components.

Develop a replacement schedule so each year the department can be removing some vests and adding new vests to the inventory. Having to replace the total inventory every five years, especially if funds are not set aside annually for that purchase, is difficult and unlikely for many agencies.

What other questions need to be asked and answered before an EMS agency purchases body armor? Share your experiences with and best practices for purchasing body armor in the comments.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor's degree from the University of Wisconsin-Madison and a master's degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on Twitter or LinkedIn and submit an article idea or ask questions with this form.